Impact of Left Hemisphere Stroke on Cognitive Functioning and Implications for Driving

左半球中风对认知功能的影响及其对驾驶的影响

• 批准号: 10295146
• 负责人: Juliana V. Baldo
• 金额: --
• 依托单位: VA NORTHERN CALIFORNIA HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10295146
• 关键词: Address; Adult; Affect; Age; American; Area; Automobile Driving; Awareness; Behavioral; Biological Markers; Brain; Brain Injuries; Brain imaging; Brain region; Chronic; Clinical; Clinical Treatment; Clinical assessments; Cognitive deficits; Complex; Computer software; Control Groups; Data; Data Analyses; Dorsal; Education; Environment; Evaluation; Exhibits; Future; Goals; Impairment; Individual; Inferior; Inferior frontal gyrus; Language; Lead; Least-Squares Analysis; Left; Lesion; Literature; Location; MRI Scans; Magnetic Resonance Imaging; Measurement; Measures; Medical Records; Neurologic; Neuropsychological Tests; Neuropsychology; Parietal; Parietal Lobe; Participant; Patients; Pattern; Performance; Prefrontal Cortex; Reaction Time; Recording of previous events; Research; Resolution; Risk; Sampling; Short-Term Memory; Site; Speed; Standardization; Stroke; Symptoms; Techniques; Training; Training Programs; Veterans; Vision; Visuospatial; Work; automobile accident; base; clinical care; cognitive function; cohort; daily functioning; disability; driving safety; education evaluation; executive function; fitness; impaired driving performance; improved; inattention; military veteran; neural correlate; performance tests; portability; post stroke; stroke patient; stroke survivor; treatment planning; visual search

Chronic disability following stroke is a significant problem for Veterans that can affect a variety of daily activities. One area of importance in clinical assessment and treatment planning is the impact of stroke on driving safety. Unfortunately, formal assessments of driving fitness and related cognitive deficits (e.g., visuospatial changes) are often not conducted in left hemisphere stroke patients. The current project will address this gap by evaluating left hemisphere stroke patients on a state-of-the-art driving simulator, comparing their performance to that of both right hemisphere stroke patients and healthy controls. Driving variables assessed by the simulator include the number of collisions, unsafe lane crossings, speed exceedances, and reaction time to stop. Different types of driving errors will then be related to performance on a neuropsychological battery, which includes standardized and experimental measures of visuospatial ability, executive functioning, and language. Last, we will investigate the neural correlates of distinct types of driving errors using voxel-based lesion symptom mapping, which relates structural lesions to behavioral performance on a voxel-by-voxel basis. Participants for the current study include 40 left and 40 right hemisphere Veteran stroke patients with no prior neurologic or severe psychiatric history. A control group of 20 age- and education-matched Veterans with no neurologic or psychiatric history will provide additional context for interpretation of the data. Driving performance will be examined with a state-of-the-art driving simulator that has been demonstrated to have strong ecological validity and predictive validity with respect to on-road driving fitness. It is predicted that 60-70% of left hemisphere patients will exhibit impaired driving performance (“failed” or “needs training” rating), significantly higher than healthy controls but not significantly different from right hemisphere patients. It is expected, however, that left hemisphere patients will show a distinct pattern of performance from right hemisphere patients. For example, it is expected that LH patients will exhibit disproportionately more errors under complex driving scenarios (e.g., in a construction zone), whereas both stroke groups will exhibit significant visuospatial driving errors (unsafe lane changes and collisions) relative to controls. Partial least squares regression will then be used to identify which neuropsychological measures are most closely related to driving performance variables measured in the simulator. It is predicted that driving errors in left hemisphere patients will correlate with both visuospatial measures (e.g., Useful Field of View/Visual Search) and executive functioning measures (e.g., Trails B). We also propose to relate structural lesion data from high-resolution 3T MRI scans to different types of driving errors. This aspect of the project will utilize voxel-based lesion symptom mapping (VLSM) software that our group helped develop. It is predicted that driving errors related to visuospatial inattention will be associated with lesions to a dorsal fronto-parietal network, whereas driving errors in complex driving scenarios will be additionally associated with lesions to a more ventral network that includes left inferior parietal and prefrontal cortex. In summary, the findings from our study will provide critical information as to the importance of driving safety referrals and evaluations following stroke, particularly in left hemisphere stroke patients. This study will advance the field by identifying neuropsychological test performance and lesion locations that should be flags for additional concern about driving safety following stroke, as well as identifying differences among left and right hemisphere stroke patients. It is our hope that the findings from this study will not only inform clinicians and patients of potential driving risks, but will ultimately provide the type of data needed to support individualized training programs in simulated driving environments for Veterans who wish to return to driving.

对于可能影响各种日常活动的退伍军人来说，中风后的慢性残疾是一个重要的问题。 临床评估和治疗计划中重要性的一个领域是中风对驾驶安全性的影响。 不幸的是，对健身和相关认知缺陷的正式评估（例如，视觉变化） 通常不在左半球中风患者中进行。当前项目将通过评估来解决这一差距 在最先进的驾驶模拟器上，左半球中风患者将其性能与 右半球中风患者和健康对照。模拟器评估的驾驶变量包括 碰撞的数量，不安全的车道交叉口，超出速度和停止反应时间。不同类型 然后，驾驶错误将与神经心理电池的性能有关，其中包括标准化 以及视觉能力，执行功能和语言的实验度量。最后，我们将调查 使用基于体素的病变症状映射的不同类型的驱动错误的神经元相关性 逐素基的行为性能的结构性病变。 当前研究的参与者包括40个左和40个右半球的中风患者 神经系统或严重的精神病史。一个20岁和教育匹配的退伍军人的对照组 神经或精神病史将为数据解释提供其他背景。驾驶性能 将使用最先进的驾驶模拟器进行检查，该模拟器已被证明具有强大的生态 有效性和预测有效性相对于公路驾驶适应性。可以预测左半球60-70％ 患者将暴露驾驶性能受损（“失败”或“需要培训”评级），大大高于 健康对照，但与右半球患者没有显着差异。但是，预计剩下 半球患者将显示出右半球患者的独特表现模式。例如，它 预计LH患者将在复杂驾驶的情况下暴露更多的错误（例如，在 一个施工区），而两个中风组都会暴露出明显的视觉驾驶误差（不安全的车道 变化和碰撞）相对于控件。然后将使用部分最小二乘回归来识别哪个 神经心理学测量与在驾驶性能变量中最密切相关 模拟器。据预测，左半球患者的驾驶错误将与两个视觉空间相关 度量（例如，视图/视觉搜索的有用字段）和执行功能措施（例如，TRAILS B）。我们也是 将结构性病变数据从高分辨率3T MRI扫描与不同类型的驱动误差联系起来的建议。 该项目的这一方面将利用基于体素的病变症状图（VLSM）软件，我们的小组帮助 发展。据预测，与视觉不注意相关的驾驶错误将与病变有关 背额额 - 顶网络，而在复杂驾驶方案中驾驶错误也将是相关的 带有更腹网的病变，其中包括左下壁和前额叶皮层。 总而言之，我们研究的发现将提供有关驾驶安全重要性的关键信息 中风后的推荐和评估，特别是在左半球中风患者中。这项研究将进步 通过识别应该成为标志的神经心理测试表现和病变位置来识别该领域 对中风后驾驶安全性的额外关注，以及确定左右之间的差异 半球中风患者。我们希望这项研究的发现不仅会为临床医生和 潜在驾驶风险的患者，但最终将提供支持个性化的数据类型 希望返回驾驶的退伍军人的模拟驾驶环境中的培训计划。